To the Editor: Dr Johns1
addressed many of the reasons why graduate medical education (GME) needs to
be reformed. There are 2 additional issues that can readily be addressed and
must be resolved if GME is to be truly reformed.

First, I agree with Relman2 that the
money and thus the influence of the pharmaceutical industry must be totally
removed from GME. If the pharmaceutical industry really intends to "play a
leading role in sponsoring continuing medical education,"3
then perhaps they would be willing to give a few billion of the 16 billion
dollars per year4 they spend on marketing
directly to academic medical centers as unrestricted educational grants so
that the fiscal problems provoked by the Balanced Budget Act of 1997 can be
ameliorated.